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PERMIT APPLICATION <br /> "RPBUILDING / MECHANICAL I PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> viaiti <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (F).425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION (p r� <br /> v <br /> PROJECT SITE ADDRESS: L 22 Q(l�YPJL/1 tit.)0t(1 PROPERTY TAX#: DO G50 2-20 I no r <br /> LEGAL for new construction: Short Plat/subdivision J Lot No. (attach copy of long legal description) <br /> n /� ` SACT INFQRWiTION \D 1A W^\ <br /> OWNER NAME: <br /> ,u <br /> 1 161 i Del 4'A (/l Mi` Ab17`jf� r feee I): Jy A S#Wt 4�t ' <br /> OWNER MAILING ADDRESS: J STREET 4% 2, (-pi- S•\-- c cE <br /> CITY ;V4'v et STATES A. ZIP eig w " <br /> OWNER PHONE: 04 2c) 9(p4 - 2-)61. OWNER EMAIL: I t 11win, e,„,.,,,,N , , //`I`'e \ <br /> CONTRACTOR NAME: J eV\\ Ta nneV1 <br /> CONTRACTOR ADDRESS: STREET I'4 (5 YZ. 6as-.I- , 6 clvi Si- v`I (� <br /> CITY 6l STATE ZIP j y i 7 <br /> CONTRACTOR PHONE:0,0 <br /> t t VVVCCC CONTRACTOR EMAIL: G!!! L7f„^^ <br /> te/) to s) -((-P4 r ,Ir-, Kin - „• . , <br /> CONTRACTOR LICENSE#(RE IRED): C Ik2 'OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) tin\D <br /> CONTACT NAME: L,1,-.0' (L I o my),e CONTACT PHONE: �U t0 (0-S1) - I i ( I <br /> CONTACT EMAIL: j ( iRv‘Ja, C r y(/l,,$VI, CAYVI <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: f 6 ry.( S k(jQ Contract Price of Work:$ '7) /0t7) <br /> Proposed Use of Building: 5 lit-k'f/1 t 14,, 0-t Heat Source: DGas ❑Electric ❑Other <br /> Building Type: DSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. OSign ❑Sprinkler emolition OChange of Use <br /> DESCRIPTION OF WORK: ; <br /> )(\it <br /> f 10k/ <br /> OJ At \-41 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn _Alteration Repair Type of Project: New _Addn _Alteration Repair <br /> #of List of Fixtures #°f List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I No. of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> 4 City of Everett Official Use Only <br /> 01 <br /> PERMITfl� O� r o15Owner/Authori d Aggeent Signature Da liO \Ii <br /> (Revised 9/23/2016) <br />